The efficacy of glucocorticoids and tocilizumab in severe and critical COVID-19 was clarified and potentially fresh promising therapeutic approaches were explained. You will find emergent data within the usefulness of baricitinib and tofacitinib in severe COVID-19, primarily if associated with glucocorticoids. Additional therapeutic strategies such as the use of convalescent plasma and anti-SARS-CoV-2 monoclonal antibodies seem to be useful only in determined subgroups of patients. How might this impact on clinical practice or further developments? This SLR informed the 2021 update of the EULAR points to consider for the use of immunomodulatory therapy in COVID-19. Introduction The SARS-CoV-2 pandemic has challenged the global healthcare system. have a DCC-2036 (Rebastinib) role for treating severe and essential COVID-19. Although better evidence is available compared with the previous SLR, the DCC-2036 (Rebastinib) need of RCT with combination therapy (glucocorticoids+anti-cytokines) versus monotherapy with glucocorticoids still remains alongside the need for standardisation of DCC-2036 (Rebastinib) inclusion criteria and results to ultimately improve the care and prognosis of affected people. This SLR educated the 2021 upgrade of the EULAR points to consider on the use of immunomodulatory therapies in COVID-19. Keywords: COVID-19, biological therapy, swelling Important communications What is already known about this subject? Several compounds with immunomodulatory Rabbit polyclonal to GST activity have been tested in individuals with SARS-CoV-2 illness at various phases of the disease. Randomised controlled tests (RCTs) are available only for a few immunomodulatory compounds/strategies, sometimes with conflicting results, and mostly for moderate to severe/essential COVID-19. What does this study add? By updating the previous systematic literature review (SLR), all the fresh RCTs published up until July 2021 were collected. The effectiveness of glucocorticoids and tocilizumab in severe and essential COVID-19 was clarified and potentially fresh promising therapeutic methods were described. You will find emergent data within the usefulness of baricitinib and tofacitinib in severe COVID-19, mainly if associated with glucocorticoids. Additional therapeutic strategies such as the use of convalescent plasma and anti-SARS-CoV-2 monoclonal antibodies seem to be useful only in selected subgroups of individuals. How might this impact on medical practice or further developments? This SLR educated the 2021 upgrade of the EULAR points to consider for the use of immunomodulatory therapy in COVID-19. Intro The SARS-CoV-2 pandemic offers challenged the global healthcare system. Severe COVID-19 pneumonia is definitely associated with swelling and immunothrombosis that may be treatable with immunomodulatory therapies but ideal treatment and timing is definitely incompletely recognized. Our previous systematic literature review (SLR)1 mentioned that despite the extremely large number of available studies, randomised controlled trials (RCTs) were few and most content articles were of lower level of evidence and at high risk of bias (RoB). Data on effectiveness (or lack thereof) of some compounds such as hydroxychloroquine (HCQ) were consistent across studies; however, for additional drugs, such as tocilizumab (TCZ), both positive and negative results were reported without a strong transmission in either direction.1 Furthermore, data growing from the gray literature, either in full as preprints or in part via press releases, added a layer of difficulty underscoring the evolving nature of COVID-19 where contradictory findings were often reported. Since fresh studies are continually published, overarching organizations regularly upgrade their recommendations for the management of COVID-19.2 3 Similarly, we conducted an update of our SLR in order to inform the 2021 update of the EULAR points to consider for the use of immunomodulatory therapy in COVID-19. Methods Search methodology Based on the same study questions of the original SLR and using the same systematic search strategy,1 a search was performed in MEDLINE, Embase, The Cochrane Database of Systematic Evaluations, CENTRAL and CINAHL. The search was carried out from 11 December 2020 (cut-off day of the previous SLR) to 14 July 2021. The PubMed Related Content articles tool was also used, and a crosscheck of the key medical journals in general medicine and immunology was performed. Non-peer-reviewed literature was excluded given this SLR aimed at informing recommendations. However, given the rapid development of knowledge on COVID-19 treatment, a parallel hand search of gray literature, restricted to RCT not yet published in peer-reviewed journals but accessible in press releases or in extenso in preprint repositories, was performed. These not yet published RCTs are offered separately and were not used to inform the points to consider. We DCC-2036 (Rebastinib) also carried out a new search to explore the effectiveness and security of anti-SARS-CoV-2 monoclonal antibodies (mAbs) in infected subjects up to 14 July 2021 (on-line supplemental text 1). Supplementary data rmdopen-2021-001899supp001.pdf Study selection, data.